Inpatient census 2016: parts one and two

1. Overview of patients being treated in NHS Scotland facilities

Number of patients and occupancy rates, by NHS Board

There were 3,633 inpatients being treated in NHS Scotland facilities at the March 2016 census, which is a decrease compared with 3,909 at the October 2014 census. The table below shows the number of mental health, learning disability and addiction inpatients being treated in each board.

Note that NHS Grampian, NHS Greater Glasgow & Clyde, NHS Lothian and NHS Tayside contain Regional Units which provide services to patients from other NHS Boards. NHS Fife also provide a low secure Learning Disability Regional Unit for the treatment of patients from other boards. NHS Orkney and NHS Shetland do not have any mental health, learning disability or addiction inpatient beds, their patients are treated by other health boards or other healthcare providers on behalf of NHS Orkney and NHS Shetland.

NHS Board of treatment	Patients (October 2014)	Patients (March 2016)
NHS Ayrshire & Arran	198	184
NHS Borders	59	45
NHS Dumfries & Galloway	77	49
NHS Fife	256	184
NHS Forth Valley	217	206
NHS Grampian	339	319
NHS Greater Glasgow & Clyde	1,105	1,111
NHS Highland	169	173
NHS Lanarkshire	346	312
NHS Lothian	670	596
NHS Orkney	0	0
NHS Shetland	0	0
NHS Tayside	334	322
NHS Western Isles	18	15
State Hospital	121	117
Scotland	3,909	3,633

Of the wards covered by the census, there were 4,254 available mental health, addiction and learning disability beds in Scotland at the March 2016 census. There were 3,633 patients occupying these beds, giving an occupancy rate of 85%, which is similar to 86% in October 2014 (see table below).

	October 2014			March 2016
NHS Board	Available beds	% occupancy		Available beds	% occupancy
NHS Ayrshire & Arran	299	66%		265	69%
NHS Borders	65	91%		57	79%
NHS Dumfries & Galloway	107	72%		85	58%
NHS Fife	346	74%		252	73%
NHS Forth Valley	240	90%		249	83%
NHS Grampian	383	89%		367	87%
NHS Greater Glasgow & Clyde	1,176	94%		1,154	96%
NHS Highland	195	87%		189	92%
NHS Lanarkshire	450	77%		440	71%
NHS Lothian	711	94%		645	92%
NHS Tayside	409	82%		402	80%
NHS Western Isles	19	95%		17	88%
State Hospital	132	92%		132	89%
Scotland	4,532	86%		4,254	85%

Note that hospitals in highly populated areas (e.g. NHS Greater Glasgow & Clyde, NHS Lothian) tend to have higher bed occupancy rates than rural areas. This is because it is easier for hospitals in close proximity to each other to move patients between facilities to maximize efficiency, whereas it is more important for rural hospitals to have spare capacity to accommodate an increase in the number of patients requiring an admission to hospital.

Annex A contains analysis of available beds for each NHS Scotland facility.

Demographics

The age and gender breakdown of patients occupying mental health, learning disability and addiction inpatients beds is largely unchanged between the October 2014 and March 2016 censuses. The following table and chart shows the age breakdown for the two years: in both cases there are more patients in the older age groups than the younger ones.

Age group	Patients (October 2014)	Patients (March 2016)
Under 18	50	55
18-39	842	806
40-64	1,369	1,267
65+	1,648	1,505
All	3,909	3,633

Number of patients, by age group (2014 v 2016)

Of the 3,633 patients in the March 2016 census, 58% were male. This is the same as in October 2014 (see below table and chart).

Patients by gender	Patients (October 2014)	Patients (March 2016)
Male	2,270	2,092
Female	1,639	1,541
All	3,909	3,633

Number of patients, by gender (2014 v 2016)

Ward Types and Security Levels

As part of the census, NHS Boards were asked to record the security level of the ward in which the patients were staying. 2,702 (74%) of all patients at the census were in a 'General Psychiatric Ward' (see below chart).

Number of patients, by ward security level, 2016

For 2016, the 'Ward Type' question in the census was expanded to include more categories. From the following chart, it can be seen that the largest ward type is 'Acute', in which there were 1,346 of the 3,633 patients (37%) were at the March census.

Number of patients, by ward type, 2016

* IPCU - Intensive Psychiatric Care Unit

Observation level

All patients in mental health inpatient settings will receive some degree of observation. However, levels of observation will vary according to the patients' individual needs. Based on current guidelines the level of observation of patients at the time of the census was recorded. The observation levels are:

• "General Observation" - Staff should have a knowledge of the patients' general whereabouts.
• "Constant Observation" - Staff should be constantly aware of the precise whereabouts of the patient.
• "Special Observation" - Patient should be in sight and within arm's reach of a member of staff.
• Enhanced care plan for therapeutic engagement - Aims to improve observation practice through therapeutic engagement with suicidal, violent or vulnerable patients to prevent them from harming themselves or others at times of high risk during their recovery.

The following chart shows that most patients (93%) fall under the General Observation category.

Patients by nurse observation level, 2016

Note: Not applicable relates to either patients who are being treated in care homes where an observation level may not apply, or patients on pass.

26 patients on Constant, Special or Enhanced Observations have at least 2 members of staff (this is 11% of those patients where this information was known).

Number of patients by number of staff involved in Constant, Special or Enhanced Observations, 2016

The most common reason, as shown in the following chart, for being on a Constant, Special or Enhanced Observation level was due to 'risk of harm to others' (69 patients) followed by 'risk of self harm' (59 patients) and 'risk of absconding' (49 patients).

Note a patient can have more than 1 reason for being on Constant, Special or Enhanced Observation.

Number of patients by reason for Constant, Special or Enhanced Observations, 2016

*Note a patient can have more than 1 reason for being on Constant, Special or Enhanced Observation.

On Pass

Patients who are "On Pass" are still formally considered inpatients of a hospital, but are permitted planned leave for varying lengths of time as part of their recovery care plan This includes those whose detention under the Mental Health Act has been suspended. At the March 2016 census there were 156 patients (4%) in Scotland who were on pass for at least that overnight period .

Boarding from another hospital

If a patient is "boarding" from another hospital, then they are staying in a hospital outwith their local catchment area. 55 people were boarding in from another hospital at the March 2016 census. 45 of these patients were boarding to another hospital in the same NHS Board as their local catchment area.

Hospital Based Complex Clinical Care

From 2016, the Inpatient Census collected information on patients receiving Hospital Based Complex Care ( HBCCC).

A patient is defined as receiving HBCCC if they have care needs that cannot be met in any setting other than hospital and require long-term complex clinical care, or have been in hospital for over 6 months. At the March 2016 census there were 1,128 patients receiving HBCCC who were occupying a mental heatlh or learning disability inpatient bed at the census date.This is 31% of all patients covered by the census.

Note, under the definition of HBCCC, no patient can be a delayed discharge.

A separate, more detailed report on HBCCC will be pulished by the Scottish Government in late September. This will cover HBCCC patients in mental health or learning disability inpatient beds, patients treated outwith NHS Scotland and patients in General Acute hospitals.

Delayed Discharge

At the census, 255 patients were a delayed discharge. This is 7% of patients for which this information is known (information was not returned for 139 patients). Of the 255 patients, 49 had a learning disability.